Can Lyme Disease Cause a Stroke? A Case of Lyme Neuroborreliosis
This case suggests it can.
Even when standard risk factors are absent.
Lyme disease stroke is a rare but serious complication that can be overlooked—especially when patients lack typical risk factors.
In a case report by Moreno Legast and colleagues, an 83-year-old man developed an ischemic stroke that was ultimately attributed to suspected Lyme neuroborreliosis.
The patient presented to the emergency room with right-sided weakness and speech difficulties that developed over 24 hours.
Lyme neuroborreliosis may lead to stroke, leaving lasting neurologic deficits.
Stroke Without Typical Risk Factors
Imaging revealed a recent ischemic lesion in the left corona radiata and a smaller parietal lesion. However, there was no evidence of hypertension, large vessel disease, or a cardiac source.
This prompted clinicians to look for alternative explanations.
Laboratory testing revealed a lupus anticoagulant—an antibody sometimes associated with clotting disorders—but the patient had no prior history of thrombosis or autoimmune disease.
Clues Pointing Toward Lyme Disease
Because antiphospholipid antibodies can be associated with infections, clinicians expanded the workup.
Initial infectious and autoimmune screenings were negative. However, Lyme disease testing returned positive results on both ELISA and Western blot.
On further review, the patient reported multiple tick bites over several years. He did not recall a rash, but had experienced tingling in his hands and feet two years earlier that lasted several months.
Spinal Tap Supports Neuroborreliosis
A spinal tap revealed elevated protein and a markedly increased Lyme IgG antibody index in the cerebrospinal fluid.
There was no pleocytosis, meaning no increase in white blood cells in the cerebrospinal fluid.
Based on European Federation of Neurological Societies criteria, this was classified as possible—but not definite—Lyme neuroborreliosis.
Treatment and Outcome
Given the concern for late-stage Lyme neuroborreliosis with cerebrovascular involvement, the patient was treated with intravenous ceftriaxone for 14 days.
The antiphospholipid antibodies resolved within six weeks.
The patient improved gradually and was discharged. He was able to walk with a cane but continued to have significant weakness in his right arm.
[bctt tweet=”Lyme disease may trigger stroke—even in patients without typical risk factors.” username=”DrDanielCameron”]
Clinical Takeaway
Lyme disease stroke should be considered in patients with unexplained neurologic events—especially when standard causes are not identified.
This case highlights how Lyme neuroborreliosis can affect the nervous system and blood vessels, potentially leading to long-term complications.
It also raises an important clinical question: could earlier recognition or additional treatment have improved the outcome?
Related Articles:
Untreated Lyme disease triggers a stroke in a 9-year-old boy
Stroke as a manifestation of Lyme disease
Cognitive issues following a stroke due to Lyme disease
Case report: Lyme neuroborreliosis more common in children
Reference:
- Moreno Legast G, et al. Ischemic Stroke: Do Not Forget Lyme Neuroborreliosis. Case Rep Neurol Med. 2018.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I used to take out around 10-20 ticks off of my head, every “weekend” in Old Saybrook/Old Lyme, CT, when I was the age of 10-16. Although, I’ve been active (sports) all my life, I have also Been sick all my life and no professional one knew why. I suffer from headaches/migraines all my life and no professional one knew why. I was finally diagnosed with Chronic Lyme in 1996. Treated with plaquenil and doxycycline.
As of 2016, I am on disability due to a stroke/endarterectomy, and no professional one knows why. What a life!,,
Have you looked a second time at whether retreatment or treatment of a co-infection might help?
I had just turned 40 and was having a hard year after losing someone close to me. I started to get I’ll. Headaches at first then migraine. Many time I found myself in hospital for a few days. No doctor had a clue but I got better and went home. At Christmas that same year I had a stroke. With much therapy I was able to go home. In the new year i still didn’t feel well but i thought i was depressed because of the stroke. Around April i went to see an eye doctor because I thought the stroke had weekend by sight. She sent me straight back to the doctor in the hospital the next day. He was able to reassure me that I was fine. This was confusing for me because I didn’t feel fine. 3 weeks later I went back to the same eye doctor who called an ambulance and had me taken to a specialist eye hospital. I then spent nearly 3 weeks in intensive care while I was tested for all number of things. My brain was swollen putting pressure on my eyes. Couldn’t move of the bed for weeks and for a few weeks after that I was in a wheelchair. Then they told me that they believed it to be limes disease. I am left feeling very week quickly and have trouble remembering stupid things and some rather important things but that was 7 years ago and I am still here.
How frustrating. I am glad you are still there.